Days after the January 12, 7.0-magnitude earthquake which killed a quarter of a million people and displaced 1.3 million in Haiti, healthcare providers realized they needed more than just doctors and nurses to help with the recovery, they also needed physical therapists (PTs). That is when the American Physical Therapy Association sent out emails to members to lead physical therapy services for amputees and others in need of rehabilitation at various hospitals across the poorest country in the western hemisphere. Seven months after the quake the need was even greater due to the thousands of amputees who received minimal treatment.

According to CNN reports, PTs were sorely needed as so many of those who managed to survive the quake had severe limb injuries or total limb loss. (Some Haitians also suffered loss of limbs due to diabetes caused illness and neglect.) That is when Sharon Gorman, PT, DPTSc, GCS, associate professor in the Doctor of Physical Therapy (DPT) Program at Samuel Merritt University (SMU) decided to forgo any summer vacation plans and board a plane to Les Cayes, Haiti, southwest of the devastated capital Port-au-Prince. There she worked alongside volunteer physical therapists and PT assistants, rehab nurses and other medical professionals who had been working round-the-clock to help injured Haitians.

Rehabilitation
"There were a lot of fractures where physicians drilled holes and created cages to help the bone heal, called an external fixator, unfortunately many patients didn't have very good nutrition or know how to take care of the devices," explains Gorman. "Six months after the quake many patients were still in the fixator which is just something you don't hear about in this country."

Months following the earthquake that leveled Port-au-Prince, the city of Les Cayes had doubled in size as the injured and homeless looked for help and a place to stay. "A lot of people were brought for surgeries and just stuck around because when your house is destroyed and unfortunately most of your family has been killed, why go back to Port-au-Prince," said Gorman.

According to the American Physical Therapy Association website, physical therapists are often the most crucial line of defense in recovery efforts. "Once doctors can determine which survivors will live following medical care, the rehabilitation options for these survivors could be brutally slim without necessary therapy, prosthetic aids and the qualified professionals who are trained in teaching the victims how to use them."

Gorman agrees. Upon her arrival she found patients lying on makeshift beds or on the ground not moving. Sometimes, those who were given crutches or other devices were not shown how to use them properly.

"When you get a prosthetic you need prosthetic training, you need a PT to teach you how to use it appropriately so that it's safe, and that you're walking safely - especially in a developing country like Haiti," said Gorman. "Walking safely around Haiti takes on a whole different meaning, nothing is paved other than the highway where you are met with tons of traffic and you're taking your life in your hands by walking on it. You've got these rutted dirt roads with rocks and livestock and you're constantly dodging motor bikes. I saw some crazy transfers from a wheelchair to the back of a motorbike because it's the only way you really get anywhere."

Endurance
For three weeks in July, in hundred degree heat, and 95 percent humidity, with frequent power outages, Gorman met hundreds of Haitians who had lost limbs, homes and families in her volunteer effort with the organization Advantage Haiti. She worked in a small Haitian-run clinic that was associated with a nearby hospital. The days were long and needs were many.

Gorman worked with patients by incorporating weight bearing through the limb to see if the weight bearing would help stimulate bone growth. "We had to do that very carefully because on some people the bones weren't healed and you're trying to stimulate the bones. If you do too much you could re-fracture the area or make it so it won't ever heal."

Despite the language barrier, Gorman says there were times when she had to be creative and careful the way you phrased things. "You can't just say, "put ice on that twice a day", they would need to buy ice. I didn't want them to feel bad if they couldn't afford or even find ice. It's not like out here where it's not a problem. That's when we had to figure out some other way to deal with the problem."

Hope and ResilienceAlong the way, there were the little surprises that she said will stay with her forever. "One person I saw who was using crutches and coming to get fit for a prosthetic came into the parking lot, which was mostly rocks and gravel, she fell and cut her foot. The fall didn't faze her, she got up and with a smile on her face came in for her appointment."

Then there was a woman we will call, 'Joy.' "Joy had a very bad femur fracture in one leg and a very bad tibia fracture on the other leg. She hadn't been walking since the earthquake and still had her external fixators on. Despite her condition, she was just a joy - always had a smile on her face, always had a kind word, and would wave to you if she saw you around the campus. Later I learned she had lost her 14 year old daughter who was sitting next to her on the day of the earthquake. Their apartment building fell down and killed her daughter and crushed [Joy's] legs. You never would know this because Joy was so sweet, positive, motivated and just thankful you were there to help her. She would sing these beautiful hymns in Creole and you would never have known this had happened to her until you asked," recalls Gorman. "It was amazing that some of these people could even make it through the day. To me Joy is the face of 'hope and resilience.'"

Classroom Material
Gorman plans on incorporating her Haiti experience into her pathology course, talking to students about the type of injuries and [lack of] resources she encountered. Dr. Gorman plans to return to Haiti next year. "I want to go back," she said. "I want to be able to help again. It truly was an experience that I'll never forget." (Gorman spent her 40th birthday in Les Cayes help caring for several Haitians.)

Currently, Haitians are dealing with a cholera epidemic that has resulted in more than 300 known deaths and 3,612 infections. According to CNN, this is the first cholera outbreak in quake-hit Haiti in more than a century.